This article looks at trends and developments in health throughout the life span, deal- ing with four specific age groups – in- fants and small children; older chil- dren and adolescents; adults up to the age of 65; and older people, with a special focus on women’s health.

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Health Promotion Guidelines across Lifespan
Intra-uterine
Oxygen
 To meet the fetal demands for oxygen, the pregnant mother gradually
increases her normal blood flow by about one-third, peaking at about 8
months.
 Respiratory rate and cardiac output increase significantly during this period.
 Feta circulation travels from the placenta through umbilical arteries, which
caries deoxygenated blood away from the fetus.
Nutrition and Fluids
 The fetus obtains nourishment from the placental circulation and by
swallowing amniotic fluid.
 Nutritional needs are met when the mother eats a well-balanced diet
containing sufficient calories and nutrients to meet both her needs and those
of the fetus.
 Adequate folic acid, one of the B vitamins, is important in order to prevent
neural tube defects
 Folic rich foods are green leafy vegetables, oranges, dried beans and suggest
she take a vitamin supplement that contain folic acid.
Rest and Activity
 The fetus sleeps most of the time and develops a pattern of sleep and
wakefulness that usually persist after birth.
 Fetal activity can be felt by the mother at about the fifth lunar month of
pregnancy
Elimination
 Fetal feces are formed in the intestines from swallowed amniotic fluid
throughout the pregnancy, but are normally not excreted until after birth.
 Urine normally is excreted into the amniotic fluid when the kidneys mature
(16 to 20 weeks).
Temperature Maintenance
 Amniotic fluid usually provides a safe and comfortable temperature for the
fetus.

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 Significant changes in the maternal temperature can alter the temperature of
the amniotic fluid and the fetus.
 Significant alter in temperature increases due to illness, hot whirlpool baths,
or saunas may result in birth defects.
 In the last weeks of gestation, the fetus develops subcutaneous fatty tissue
stores that will help maintain body temperature at birth.
Safety
 The body systems form during the embryonic period. As a result, the embryo
is particularly vulnerable to damage from teratogen, which is anything that
adversely affects normal cellular development in the embryo or fetus.
 It is important for the nurse to inquire about possible pregnancy when giving
medications that are known teratogens and also ask when the woman is
scheduled for tests that involve radiography (x-ray).
 Smoking, alcohol, and drugs can affect the environment for the fetus. Smoking
has been associated with preterm labor, spontaneous abortion, low-birth
weight infants, and sudden infant death syndrome and learning disorders.
 Fetal alcohol syndrome (FAS), a result of impaired mitochondrial
development, leads to microcephaly, mental retardation, learning disorders,
and other central nervous system defects.
Infants
Health Examinations
 Screening of newborns for hearing loss; follow-up at 3 months and early
intervention by 6 months if appropriate
 At 2 weeks and at 2,4,6, and 12 months
Protective Measures
 Immunizations: diptheria,tetanus, acellular pertussis (DTaP), inactivated
poliovirus vaccine (IVP), pneumococcal, measles-mumps-rubella (MMR),
Haemophilus influenzae type B (HIB), hepatitis B (HepB), varicella and
influenza vaccines as recommended
 Fluoride supplements if there is adequate water fluoridation (less than 0.7
part per million)
 Screening for tuberculosis
 Screening for phenylketonuria (PKU) and other metabolic conditions
 Prompt attention for illnesses
 Appropriate skin hygiene and clothing

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Infant Safety
 Importance of supervision
 Car seat, crib, playpen, bath, and home environment safety ,measures
 Feeding measures (e.g., avoid propping bottle)
 Provide toys with no small parts or sharp edges
 Eliminate toxins in the environment (e.g., chemicals, radon, lead, mercury)
 Use smoke and carbon monoxide (CO) detectors in home
Nutrition
 Breast-feeding to age 12 months
 Breast-feeding and bottle feeding techniques
 Formula preparation
 Feeding schedule
 Introduction of solid foods
 Need for iron supplements at 4 to 6 months
Elimination
 Characteristics and frequency of stool and urine elimination
 Diarrhea and its effects
Rest/ Sleep
 Establish routine for sleep and rest patterns
Sensory Stimulation
 Touch: holding, cuddling, rocking
 Vision: colorful, moving toys
 Hearing: soothing voice tones, music, singing
 Play: toys appropriate for development
Toddlers
Health Examinations
 At 15 and 18 months and then as recommended by the primary care provider
 Dental visit starting at age of 3 or earlier

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Protective Measures
 Immunizations: continuing DTaP, IPV series, pneumococcal, MMR,
Haemophilus influenzae type B, hepatitis, hepatitis A, and influenza vaccines
as recommended
 Screenings for tuberculosis and lead poisoning
 Fluoride supplements if there is inadequate water fluoridation (less than 0.7
part per million)
Toddler Safety
 Importance of constant supervision and teaching child to obey commands
 Home environment safety measures (e.g., lock medicine cabinet)
 Outdoor safety measures (e.g., close supervision near water)
 Appropriate toys
 Eliminate toxins in environment (e.g., pesticides, herbicides, mercury, lead,
arsenic in playground materials)
 Use smoke and carbon monoxide (CO) detectors in home
Nutrition
 Importance of nutritious meals and snacks
 Teaching simple mealtime manners
 Dental care
Elimination
 Toilet training techniques
Rest/Sleep
 Dealing with sleep disturbances
Play
 Providing adequate space and variety of activities
 Toys that allow “acting on” behaviors and provide motor and sensory
stimulation
Preschoolers
Health Examinations
 Every 1 to 2 years

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Protective Measures
 Immunizations: continuing DTaP, IPV series, MMR, hepatitis, pneumococcal,
influenza, and other immunizations as recommended
 Screenings for tuberculosis
 Vision and hearing screening
 Regular dental screenings and fluoride treatment
Preschooler Safety
 Educating child about simple safety rules (e.g., crossing the street)
 Teaching child to play safely (e.g., bicycle and playground safety)
 Educating to prevent poisoning; exposure to toxic materials
Nutrition
 Importance of nutritious meals and snacks
Elimination
 Teaching proper hygiene (e.g., washing hands after using bathroom)
Rest/ Sleep
 Dealing with sleep disturbances (e.g., night terrors, sleepwalking)
Play
 Providing times for group play activities
 Teaching child simple games that require cooperation and interaction
 Providing toys and dress-ups for role-playing
School-Age Children
Health Examinations
 Annual physical examination or as recommended
Protective Measures
 Immunizations as recommended (e.g., MMR, meningococcal, tetanus-
diphtheria, adult preparation [Td])
 Screening for tuberculosis
 Periodic vision, speech, and hearing screenings
 Regular dental screenings and fluoride treatment

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 Providing accurate information about sexual issues (e.g., reproduction, AIDS)
School-Age Child Safety
 Using proper equipment when participating in sports and other physical
activities (e.g., helmets, pads)
 Encouraging child to take responsibility for own safety (e.g., participating in
bicycle and water safety courses)
Nutrition
 Importance of child not skipping meals and eating balance diet
 Experiences with food that may lead to obesity
Elimination
 Utilizing positive approaches for elimination problems (e.g., enuresis)
Play and Social Interactions
 Providing opportunities for a variety of organized group activities
 Accepting realistic expectations of child’s abilities
 Acting as role models in acceptance of other persons who may be different
 Providing a home environment that limits TV viewing and video games and
encourages completion of homework and healthy exercise
Adolescents
Health Examinations
 As recommended by the primary care provider
Protective Measures
 Immunizations as recommended, such as adult tetanus –diphtheria vaccine,
MMR, pneumococcal, and hepatitis B vaccine
 Screening for tuberculosis
 Periodic vision and hearing screenings
 Regular dental assessments
 Obtaining and providing accurate information about sexual issues
Adolescent Safety
 Adolescent’s taking responsibility for using motor vehicles safely (e.g.,
completing a driver’s education course, wearing seat belt and helmet)

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 Making certain that proper precautions are taken during all athletic activities
(e.g., medical supervision, proper equipment)
 Parent’s keeping lines of communication open and being alert to signs of
substance abuse and emotional disturbances in the adolescent
Nutrition and Exercise
 Importance of healthy snacks and appropriate patterns of food intake and
exercise
 Factors that may lead to nutritional problems (e.g., obesity , anorexia nervosa,
bulimia)
 Balancing sedentary activities with regular exercise
Social Interactions
 Encouraging and facilitating adolescent success in school
 Encouraging adolescent to establish relationships that promote discussion of
feelings, concerns, and fears.
 Parents’ encouraging adolescent peer group activities that promote
appropriate moral and spiritual values
 Parents’ acting as role models for appropriate social interactions
 Parents’ providing a comfortable home environment for appropriate
adolescent peer group activities
 Parents’ expecting adolescents to participate in and contribute to family
activities
Young Adults
Health Test and Screenings
 Routine physical examination (every 1 to 3 years for females; every 5 years for
males)
 Immunizations as recommended, such as tetanus-diphtheria boosters every 0
years, meningococcal vaccine if not given in early adolescence, and hepatitis B
vaccine
 Regular dental assessments (every 6 months)
 Periodic vision and hearing screenings
 Professional breast examination every 1 to 3 years
 Papanicolaou smear annually within 3 years of onset of sexual activity
 Testicular examination every year
 Screening for cardiovascular disease (e.g., cholesterol test every 5 years if
results are normal; blood pressure to detect hypertension; baseline
electrocardiogram at age 35)
 Tuberculosis skin test every 2 years

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 Smoking: history and counseling if needed
Safety
 Motor vehicle safety reinforcement (e.g., using designated drivers when
drinking, maintaining brakes and tires)
 Sun protection measures
 Workplace safety measures
 Water safety reinforcement (e.g., no diving in shallow water)
Nutrition and Exercise
 Importance of adequate iron intake in diet
 Nutritional and exercise factors that may lead to cardiovascular disease (e.g.,
obesity, cholesterol, and fat intake, lack of vigorous exercise)
Social Interactions
 Encouraging personal relationship that promote discussion of feelings,
concerns, and fears
 Setting short-and long- term goals for work and career choices
Middle-Aged Adults
Health Test and Screening
 Physical examination (every 3 to 5 years until age 40, then annually)
 Immunizations as recommended, such as a tetanus booster every 10 years,
and current recommendations for influenza vaccine.
 Regular dental assessments (e.g., every 6 months)
 Tonometry for signs of glaucoma and other eye diseases every 2 to 3 years or
annually if indicated
 Breast examination annually by primary care provider
 Testicular examination annually by primary care provider
 Screenings for cardiovascular disease (e.g., blood pressure measurement;
electrocardiogram and cholesterol test as directed by the primary care
provider)
 Screenings for colorectal, breast, cervical, uterine, and prostate cancer
 Screening for tuberculosis every 2 years
 Smoking: history and counseling, if needed
Safety
 Motor vehicle safety reinforcement, especially when driving at night

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 Workplace safety measures
 Home safety measures: keeping hallways and stairways lighted and
uncluttered, using smoke detector, using nonskid mats and handrails in the
bathrooms
Nutrition and Exercise
 Importance of adequate protein, calcium, and vitamin D in diet
 Nutritional and exercise factors that may lead to cardiovascular disease (e.g.,
obesity, cholesterol and fat intake, lack of vigorous exercise)
 An exercise program that emphasizes skill and coordination
Social Interactions
 The possibility of a middle crisis: encourage discussion of feelings, concerns,
and fears
 Providing time to expand and review previous interests
 Retirement planning (financial and possible diversional activities), with
partner if appropriate
Elders
Health Test and Screening
 Total cholesterol and high density lipid protein measurement every 3 to 5
years until age 75
 Aspirin, 81 mg daily, if in high- risk group
 Diabetes mellitus screen every 3 years, if in high-risk group
 Smoking cessation
 Screening mammogram every 1 to 2 years (women)
 Clinical breast exam annually (women)
 Pap smear annually if there is a history of abnormal smears or previous
hysterectomy of malignancy (United States Preventive Services Task Force,
2003)
o Older women who have regular, normal Pap smear or hysterectomy for
nonmalignant causes do NOT need Pap smear beyond the age of 65
 Annual digital rectal exam
 Annual prostate-specific antigen (PSA)
 Annual fecal occult blood test (FOBT)
 Sigmoidoscopy every 5 years; colonoscopy every 10 years
 Visual acuity screen annually
 Hearing screen annually
 Depression screen periodically
 Family violence screen periodically

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 Height and weight measurements annually
 Sexually transmitted disease testing, if high- risk group
 Annual flu vaccine if over 65 or in high-risk group
 Pneumococcal vaccine at 65 and every 10 years thereafter
 Td vaccine every 10 years
Safety
 Home safety measures to prevent falls, fire, burns, scalds, and electrocution
 Working smoke detectors and carbon monoxide detectors in the home
 Motor vehicle safety reinforcement, especially when driving at night
 Elder driver skills evaluation (some states require for license renewal)
 Precautions to prevent pedestrian accidents
Nutrition and Exercise
 Importance of a well-balanced diet with fewer calories to accommodate lower
metabolic rate and decreased physical activity
 Importance of sufficient amounts of vitamin D and calcium to prevent
osteoporosis
 Nutritional and exercise factors that may lead to cardiovascular disease (e.g.,
obesity, cholesterol and fat intake, lack of exercise)
 Importance of 30 minutes of moderate physical activity daily; 20 minutes of
vigorous physical activity 3 times per week
Elimination
 Importance of adequate roughage in the diet, adequate exercise, and at least
six 8-once glasses of fluid daily to prevent constipation
Social Interaction
 Encouraging intellectual and recreational pursuits
 Encouraging personal relationships that promote discussion of feelings,
concerns, and fears
 Assessment of risk factors for maltreatment
 Availability of social community centers and programs for seniors

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